Outcome of patients with functional single ventricular heart after pacemaker implantation: What makes it poor, and what can we do?

Yoshihiko Kodama, Ayako Kuraoka, Yuichi Ishikawa, Makoto Nakamura, Hiroya Ushinohama, Koichi Sagawa, Shintaro Umemoto, Toru Hashimoto, Ichiro Sakamoto, Kisho Ohtani, Tomomi Ide, Hiroyuki Tsutsui, Shiro Ishikawa

Research output: Contribution to journalArticle

Abstract

Background: Pacemaker implantation in patients with single ventricle is associated with poor outcomes. Objective: The purpose of this study was to determine the reasons for the poor outcomes of pacemaker implantation. Methods: We performed a retrospective chart review of patients with single ventricle who had undergone permanent pacemaker implantation. Patients were categorized into 3 groups based on the site of pacing and the proportion of ventricular pacing (VP) as follows: (1) atrial pacing group with atrial pacing only (n = 11); (2) low VP group with low daily VP proportion (<50%; n = 12); and (3) high VP group with high daily VP proportion (≥50%; n = 15). Pacing leads were placed at the epicardium in all patients. Results: No patients in the atrial pacing or low VP groups died, whereas the survival rate in the high VP group was 58.9% and 39.3% at 10 and 20 years, respectively, after pacemaker implantation. Among the post-Fontan patients, plasma brain natriuretic peptide (BNP) levels significantly increased with the proportion of VP: 11.7, 20.3, and 28.4 pg/mL in the atrial pacing, low VP, and high VP groups, respectively (P = 0.04). In the high VP group, the plasma BNP level was significantly lower in patients with an apical pacing lead than in those with a nonapical pacing lead (27.0 pg/mL vs 82.8 pg/mL, respectively; P = .03). Conclusion: A higher proportion of VP was associated with poor outcome and higher plasma BNP levels, probably due to ventricular dyssynchrony. In epicardial ventricular pacing, apical pacing is better to avoid the increase in ventricular stress and plasma BNP level.

Original languageEnglish
Pages (from-to)1870-1874
Number of pages5
JournalHeart Rhythm
Volume16
Issue number12
DOIs
Publication statusPublished - Dec 2019

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Brain Natriuretic Peptide
Pericardium
Survival Rate

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kodama, Y., Kuraoka, A., Ishikawa, Y., Nakamura, M., Ushinohama, H., Sagawa, K., ... Ishikawa, S. (2019). Outcome of patients with functional single ventricular heart after pacemaker implantation: What makes it poor, and what can we do? Heart Rhythm, 16(12), 1870-1874. https://doi.org/10.1016/j.hrthm.2019.06.019

Outcome of patients with functional single ventricular heart after pacemaker implantation : What makes it poor, and what can we do? / Kodama, Yoshihiko; Kuraoka, Ayako; Ishikawa, Yuichi; Nakamura, Makoto; Ushinohama, Hiroya; Sagawa, Koichi; Umemoto, Shintaro; Hashimoto, Toru; Sakamoto, Ichiro; Ohtani, Kisho; Ide, Tomomi; Tsutsui, Hiroyuki; Ishikawa, Shiro.

In: Heart Rhythm, Vol. 16, No. 12, 12.2019, p. 1870-1874.

Research output: Contribution to journalArticle

Kodama, Y, Kuraoka, A, Ishikawa, Y, Nakamura, M, Ushinohama, H, Sagawa, K, Umemoto, S, Hashimoto, T, Sakamoto, I, Ohtani, K, Ide, T, Tsutsui, H & Ishikawa, S 2019, 'Outcome of patients with functional single ventricular heart after pacemaker implantation: What makes it poor, and what can we do?', Heart Rhythm, vol. 16, no. 12, pp. 1870-1874. https://doi.org/10.1016/j.hrthm.2019.06.019
Kodama, Yoshihiko ; Kuraoka, Ayako ; Ishikawa, Yuichi ; Nakamura, Makoto ; Ushinohama, Hiroya ; Sagawa, Koichi ; Umemoto, Shintaro ; Hashimoto, Toru ; Sakamoto, Ichiro ; Ohtani, Kisho ; Ide, Tomomi ; Tsutsui, Hiroyuki ; Ishikawa, Shiro. / Outcome of patients with functional single ventricular heart after pacemaker implantation : What makes it poor, and what can we do?. In: Heart Rhythm. 2019 ; Vol. 16, No. 12. pp. 1870-1874.
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abstract = "Background: Pacemaker implantation in patients with single ventricle is associated with poor outcomes. Objective: The purpose of this study was to determine the reasons for the poor outcomes of pacemaker implantation. Methods: We performed a retrospective chart review of patients with single ventricle who had undergone permanent pacemaker implantation. Patients were categorized into 3 groups based on the site of pacing and the proportion of ventricular pacing (VP) as follows: (1) atrial pacing group with atrial pacing only (n = 11); (2) low VP group with low daily VP proportion (<50{\%}; n = 12); and (3) high VP group with high daily VP proportion (≥50{\%}; n = 15). Pacing leads were placed at the epicardium in all patients. Results: No patients in the atrial pacing or low VP groups died, whereas the survival rate in the high VP group was 58.9{\%} and 39.3{\%} at 10 and 20 years, respectively, after pacemaker implantation. Among the post-Fontan patients, plasma brain natriuretic peptide (BNP) levels significantly increased with the proportion of VP: 11.7, 20.3, and 28.4 pg/mL in the atrial pacing, low VP, and high VP groups, respectively (P = 0.04). In the high VP group, the plasma BNP level was significantly lower in patients with an apical pacing lead than in those with a nonapical pacing lead (27.0 pg/mL vs 82.8 pg/mL, respectively; P = .03). Conclusion: A higher proportion of VP was associated with poor outcome and higher plasma BNP levels, probably due to ventricular dyssynchrony. In epicardial ventricular pacing, apical pacing is better to avoid the increase in ventricular stress and plasma BNP level.",
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T1 - Outcome of patients with functional single ventricular heart after pacemaker implantation

T2 - What makes it poor, and what can we do?

AU - Kodama, Yoshihiko

AU - Kuraoka, Ayako

AU - Ishikawa, Yuichi

AU - Nakamura, Makoto

AU - Ushinohama, Hiroya

AU - Sagawa, Koichi

AU - Umemoto, Shintaro

AU - Hashimoto, Toru

AU - Sakamoto, Ichiro

AU - Ohtani, Kisho

AU - Ide, Tomomi

AU - Tsutsui, Hiroyuki

AU - Ishikawa, Shiro

PY - 2019/12

Y1 - 2019/12

N2 - Background: Pacemaker implantation in patients with single ventricle is associated with poor outcomes. Objective: The purpose of this study was to determine the reasons for the poor outcomes of pacemaker implantation. Methods: We performed a retrospective chart review of patients with single ventricle who had undergone permanent pacemaker implantation. Patients were categorized into 3 groups based on the site of pacing and the proportion of ventricular pacing (VP) as follows: (1) atrial pacing group with atrial pacing only (n = 11); (2) low VP group with low daily VP proportion (<50%; n = 12); and (3) high VP group with high daily VP proportion (≥50%; n = 15). Pacing leads were placed at the epicardium in all patients. Results: No patients in the atrial pacing or low VP groups died, whereas the survival rate in the high VP group was 58.9% and 39.3% at 10 and 20 years, respectively, after pacemaker implantation. Among the post-Fontan patients, plasma brain natriuretic peptide (BNP) levels significantly increased with the proportion of VP: 11.7, 20.3, and 28.4 pg/mL in the atrial pacing, low VP, and high VP groups, respectively (P = 0.04). In the high VP group, the plasma BNP level was significantly lower in patients with an apical pacing lead than in those with a nonapical pacing lead (27.0 pg/mL vs 82.8 pg/mL, respectively; P = .03). Conclusion: A higher proportion of VP was associated with poor outcome and higher plasma BNP levels, probably due to ventricular dyssynchrony. In epicardial ventricular pacing, apical pacing is better to avoid the increase in ventricular stress and plasma BNP level.

AB - Background: Pacemaker implantation in patients with single ventricle is associated with poor outcomes. Objective: The purpose of this study was to determine the reasons for the poor outcomes of pacemaker implantation. Methods: We performed a retrospective chart review of patients with single ventricle who had undergone permanent pacemaker implantation. Patients were categorized into 3 groups based on the site of pacing and the proportion of ventricular pacing (VP) as follows: (1) atrial pacing group with atrial pacing only (n = 11); (2) low VP group with low daily VP proportion (<50%; n = 12); and (3) high VP group with high daily VP proportion (≥50%; n = 15). Pacing leads were placed at the epicardium in all patients. Results: No patients in the atrial pacing or low VP groups died, whereas the survival rate in the high VP group was 58.9% and 39.3% at 10 and 20 years, respectively, after pacemaker implantation. Among the post-Fontan patients, plasma brain natriuretic peptide (BNP) levels significantly increased with the proportion of VP: 11.7, 20.3, and 28.4 pg/mL in the atrial pacing, low VP, and high VP groups, respectively (P = 0.04). In the high VP group, the plasma BNP level was significantly lower in patients with an apical pacing lead than in those with a nonapical pacing lead (27.0 pg/mL vs 82.8 pg/mL, respectively; P = .03). Conclusion: A higher proportion of VP was associated with poor outcome and higher plasma BNP levels, probably due to ventricular dyssynchrony. In epicardial ventricular pacing, apical pacing is better to avoid the increase in ventricular stress and plasma BNP level.

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